Physician a pioneer in cancer treatment

1/13/2005

Dr. Walter Quan

Theodore Hill woke up one day in July with chest pains. It wasn't a heart attack. Somehow he knew that. But this morning, he gasped as though the air of his room had thinned overnight.

His doctor ordered X-rays, and those told the story. In each lung was an amorphous blotch that didn't belong. This was cancer - for Mr. Hill the second chapter in his bout with kidney cancer. In Chapter 1, which took place in 2003, surgeons removed a diseased kidney. They warned him then that he was at high risk for more cancer. Now, here it was.

The reappearance was far worse than the initial diagnosis. This time, doctors told the 48-year-old accountant that there could be no surgery. Nor was there a chemotherapy to treat metastatic kidney cancer. Radiation offered no hope.

"They really could do nothing,'' said Mr. Hill of Glenmere Way in South Toledo. "I was pretty shaken." He didn't spend much time worrying about himself. Instead he fretted about his wife, Mary, and his five children - two of them still at home - and his parents. What would happen to them?

His condition looked hopeless. Every medical conversation was a dead end. Then, in October, his wife was diagnosed with cancer. She's since had a lung removed. Things were bleak.

Then he met Walter Quan. Dr. Quan had just arrived at the Medical College of Ohio from Eastern Carolina University to become chief of oncology at the Toledo hospital.

That meeting changed everything. Dr. Quan said he could help Mr. Hill. He had a way to treat not only patients with metastatic kidney cancer like Mr. Hill's, he could help folks with metastatic melanoma too.

"For melanoma and kidney cancer, the 100-plus chemotherapy drugs have really no effect at all,'' Dr. Quan said. Typically, people diagnosed with metastatic kidney cancer live only six months. Those with spreading melanoma survive an average of seven months beyond diagnosis.

But Dr. Quan's treatment, using an immune system chemical called Interleukin-2, is already prolonging life beyond those deadlines. Dr. Quan can't say how long people may live after this treatment, because more than half of the patients who have tried it are still alive.

A paper he wrote in the current issue of Cancer Biotherapy and Radiopharmaceuticals shows 64 percent of melanoma patients - nine of 14 - saw tumors shrink with the Interleukin treatment. Later this month, a second paper will show two of six kidney cancer patients responded, a 33 percent response rate.

Dr. Quan isn't the only physician using Interleukin-2 to treat these cancers, though it's not common. A handful of physicians nationwide are trying different doses of Interleukin, doled out in various patterns, and in combination with other drugs, in hopes of improving results. So far, those other forms of Interleukin-2 therapy shrink cancers in no more than 15 percent of the patients who undergo the treatment.

That's what makes Dr. Quan's work, with its high response rates, so different.

"I think the number of responses is impressive, but it's only 14 patients,'' said Robert Dillman, director of the Hoag Cancer Center in Newport Beach, Calif. "If that holds up with larger numbers [of patients], then that's impressive. The response rate we normally think is best is usually 20 percent. That's why this 64 percent catches your attention."

"The logic behind this approach of Dr. Quan's is sound and worth pursuing further,'' said Paul Sondell of the University of Wisconsin Comprehensive Cancer Center. His research team may refine Interleukin treatment even further. They are attaching the chemical to an antibody capable of honing in directly on cancer cells.

But the real test of the Interleukin therapies will be whether they actually let people live longer cancer-free, said Robert K. Oldham, editor of Cancer Biotherapies, the journal that published Dr. Quan's research. It's too early to tell whether Dr. Quan's approach has an advantage for survival, he said.

Often, when Interleukin-2 is administered, it is given in five high-dose shots. While this helps some patients, it's physically brutal. Because of the risks, elderly people cannot be treated with this high-dose therapy. About 2 percent of the patients on high-dose Interleukin die. Ten to 20 percent end up in an intensive-care unit as a result of complications.

Dr. Quan, whose grandmother died of the complications of chemotherapy, hopes to minimize the side effects of Interleukin while enhancing its effects. He gives fairly high doses of Interleukin-2 by intravenous drip for three days, followed by a day off of therapy. On the fifth day, the patient finishes with a single shot of a day's worth of Interleukin. The patient is in the hospital the entire five days.

It's not much fun. Nausea, vomiting, chills, high temperatures, and an irregular heart beat all come with the territory. The skin peeled off Mr. Hill's hands, throat, and nose during one treatment session. Then, for the week following treatment, he has no energy. He can't taste anything. He's just dragging. But he loves it.

"When it's time for me to have a treatment, I look forward to it. I don't dread it. I know this is my road to get well.''

So far he's taken four Interleukin-2 treatments. And he intends to keep going as long as he can. This month, he learns if his tumors are smaller.

"I feel a lot better,'' he said. "I get pain every now and then, but that's even subsided. I don't have to take my pain medication as much.'' Also, he's able to return to many activities he likes to do, like lifting weights.

Dr. Quan says all these things make him optimistic about Mr. Hill's condition. Until X-ray results are in, Mr. Hill can take heart in the story of Thomas Roberts, 73, of Wilson, N.C. His kidney cancer had reached his lungs and liver when he was told there was nothing anyone could do. His own search led him to Dr. Quan.

"I've had 14 treatments. My cancer is 70 percent dried up,'' he said. "Interleukin 2 - it works. I don't understand why more people don't have it,'' he said. "I'm just so excited I'm still here. It's been a year, and I'm back in the swing of things."

Contact Jenni Laidman at:

jenni@theblade.com

or 419-724-6507.